مورد إلكتروني
Aortic Neck IFU Violations During EVAR for Ruptured Infrarenal Aortic Aneurysms are Associated with Increased In-Hospital Mortality.
| العنوان: | Aortic Neck IFU Violations During EVAR for Ruptured Infrarenal Aortic Aneurysms are Associated with Increased In-Hospital Mortality. |
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| المؤلفون: | Zarkowsky, Devin S |
| بيانات النشر: | eScholarship, University of California 2021-08-01 |
| تفاصيل مُضافة: | Zarkowsky, Devin S Sorber, Rebecca Ramirez, Joel L Goodney, Philip P Iannuzzi, James C Wohlauer, Max Hicks, Caitlin W |
| نوع الوثيقة: | Electronic Resource |
| مستخلص: | ObjectiveVascular surgeons treating patients with ruptured abdominal aortic aneurysm must make rapid treatment decisions and sometimes lack immediate access to endovascular devices meeting the anatomic specifications of the patient at hand. We hypothesized that endovascular treatment of ruptured abdominal aortic aneurysm (rEVAR) outside manufacturer instructions-for-use (IFU) guidelines would have similar in-hospital mortality compared to patients treated on-IFU or with an infrarenal clamp during open repair (ruptured open aortic aneurysm repair [rOAR]).MethodsVascular Quality Initiative datasets for endovascular and open aortic repair were queried for patients presenting with ruptured infrarenal AAA between 2013-2018. Graft-specific IFU criteria were correlated with case-specific proximal neck dimension data to classify rEVAR cases as on- or off-IFU. Univariate comparisons between the on- and off-IFU groups were performed for demographic, operative and in-hospital outcome variables. To investigate mortality differences between rEVAR and rOAR approaches, coarsened exact matching was used to match patients receiving off-IFU rEVAR with those receiving complex rEVAR (requiring at least one visceral stent or scallop) or rOAR with infrarenal, suprarenal or supraceliac clamps. A multivariable logistic regression was used to identify factors independently associated with in-hospital mortality.Results621 patients were treated with rEVAR, with 65% classified as on-IFU and 35% off-IFU. The off-IFU group was more frequently female (25% vs. 18%, P = 0.05) and had larger aneurysms (76 vs. 72 mm, P= 0.01) but otherwise was not statistically different from the on-IFU cohort. In-hospital mortality was significantly higher in patients treated off-IFU vs. on-IFU (22% vs. 14%, P= 0.02). Off-IFU rEVAR was associated with longer operative times (135 min vs. 120 min, P= 0.004) and increased intraoperative blood product utilization (2 units vs. 1 unit, P= 0.002). When off-IFU patients wer |
| مصطلحات الفهرس: | Humans, Aortic Rupture, Aortic Aneurysm, Abdominal, Postoperative Complications, Treatment Outcome, Blood Vessel Prosthesis Implantation, Hospital Mortality, Risk Assessment, Risk Factors, Retrospective Studies, Prosthesis Design, Blood Vessel Prosthesis, Comorbidity, Time Factors, Product Labeling, Databases, Factual, Aged, Guideline Adherence, Female, Male, Practice Guidelines as Topic, Endovascular Procedures, Clinical Decision-Making, Clinical Research, Cardiovascular, Rare Diseases, Clinical Sciences, Cardiovascular System & Hematology, publication |
| URL: | |
| الإتاحة: | Open access content. Open access content public |
| ملاحظة: | application/pdf |
| أرقام أخرى: | CDLER oai:escholarship.org:ark:/13030/qt8mx6b8mz qt8mx6b8mz https://escholarship.org/uc/item/8mx6b8mzTest https://escholarship.orgTest/ 1391595075 |
| المصدر المساهم: | UC MASS DIGITIZATION From OAIster®, provided by the OCLC Cooperative. |
| رقم الانضمام: | edsoai.on1391595075 |
| قاعدة البيانات: | OAIster |
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